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The goal of this observational study is to examine whether intrahepatic blood flow occlusion strategies during partial hepatectomy are associated with postoperative cardiac injury in patients undergoing hepatectomy. The primary questions it seeks to address are:
Liver resection is currently the primary surgical treatment for liver tumors, injuries, and other diseases. With the continuous development of surgical techniques, its application has been expanding. However, intraoperative bleeding and poor surgical field exposure remain major challenges in liver resection, seriously affecting the safety and efficacy of the operation.
Hepatic inflow occlusion is a commonly used technique to address these challenges. It can effectively reduce intraoperative bleeding and improve surgical field exposure. However, it can also lead to hepatic ischemia-reperfusion injury, which may aggravate the damage to the remnant liver and even affect liver regeneration.
Recent studies suggest that hepatic ischemia-reperfusion injury may affect distant organs such as the kidneys, brain, lungs, and heart. However, there is still insufficient clinical evidence, especially regarding myocardial injury. In addition, intraoperative hypotension is a common complication of liver resection and may exacerbate the impact of ischemia-reperfusion injury on the myocardium.
This study intends to construct a model incorporating variables related to intraoperative hepatic ischemia and reperfusion, and analyze the relationship between hepatic inflow occlusion and postoperative myocardial injury in liver resection using logistic regression, while considering the mediating effect of hypotension. The results of this study will provide important clinical evidence for optimizing liver resection strategies, reducing myocardial injury, and improving patient prognosis. This research holds significant scientific and clinical value, and is expected to improve the quality of liver surgery and patient survival rates.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No Occlusion | During the entire operation, no blood flow to the liver was occluded. | ||
| Portal Vein Occlusion | During the entire procedure, only the portal vein was occluded. |
| |
| Pringle Occlusion | Pringle occlusion was performed throughout the operation. |
| |
| Both Occlusion | Both Pringle occlusion and portal vein block were performed throughout the procedure. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| intrahepatic blood flow occlusion | Procedure | The specified blood vessel is temporarily clamped to achieve the intended blockage of blood flow. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Myocardial injury after non-cardiac surgery (MINS) | a high-sensitivity troponin T (hs-TnT) of 20 to <65 ng/L with an absolute change of at least 5 ng/L | Within 3 days after sugery |
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Inclusion Criteria:
Hospitalized patients aged ≥18 years who underwent partial hepatectomy between November 28, 2004, and May 20, 2024.
Exclusion Criteria:
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Hospitalized patients aged ≥18 years who underwent partial hepatectomy.
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| ID | Term |
|---|---|
| D007022 | Hypotension |
| D015427 | Reperfusion Injury |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
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| D013568 | Pathological Conditions, Signs and Symptoms |